What Can Be Done To Prevent Lung Cancer – Advances in cancer are changing the way oncologists treat people with lung cancer, tailoring treatments to a patient’s unique type of cancer. Global Lung Cancer Patient Advocacy Panel reviews key developments in lung cancer and highlights the importance of biomarker testing.
Promising medical advances are changing how oncologists and surgeons treat people with lung cancer. Learning that you or a family member has lung cancer can be overwhelming, but today there is more hope than ever. Treatment plans can now be tailored to each patient’s specific lung cancer subtype to prolong survival and improve quality of life.
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This article will review key developments in the diagnosis and treatment of patients with lung cancer, focusing on the importance of biomarker testing. This will give patients the knowledge to help them work with their medical team to ensure that the treatment plan is right for them. Much of the information, ideas, and recommendations in this article come from global experts in lung cancer advocacy who belong to the Global Lung Cancer Coalition (GLCC), an alliance of patient organizations dedicated to increasing lung cancer awareness. improve outcomes in cancer and lung cancer (see Table 1).
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In February 2018, experts from the United States, Canada, Mexico, Indonesia, and the European Union met in Cambridge, Massachusetts for the GLCC Roundtable sponsored by Takeda Oncology. Roundtable participants on the unique needs of lung cancer patients; difficulties with worldwide access to biomarker testing; and the value of using biomarker test results to inform treatment decisions.
This article is divided into 3 parts. The first section reviews lung cancer and its various subtypes, as well as the types of biomarker tests and why they are important. The second section highlights GLCC roundtable participants’ perceptions and ideas regarding patient education and access to lung cancer care. The final section provides practical advice for patients diagnosed with lung cancer and their caregivers on how to communicate with their healthcare team about biomarker testing and treatment options.
Lung cancer begins when abnormal lung cells grow out of control. However, the term “lung cancer” is very broad. There are several stages and types (or subtypes) of lung cancer. Lung cancer can manifest differently in different people depending on factors such as its stage and subtype.
If lung cancer is diagnosed and treated at an early stage (before it has spread), the chances of successful treatment are higher than at a later stage. So when oncologists “stage” a patient’s cancer, they want to know how far the cancer has spread from its original source. The 4 main stages of lung cancer are shown in Figure 1
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Oncologists and surgeons use information about lung cancer stages to help decide whether surgery, radiation, chemotherapy, or other cancer-targeting drugs are best.
Knowledge is power as oncologists, surgeons and other cancer care providers develop treatment plans for lung cancer patients. The more they learn about the characteristics of a patient’s tumor, the more likely they are to target the cancer with a specific type of treatment.
This means that in addition to identifying a patient’s lung cancer by size, location, and spread, doctors also take samples of lung cancer tissue.
Tissue is usually taken from a patient’s lung after a biopsy or surgical removal (or resection) of a tumor.
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Remember, lung cancer is not one disease. There are different types (subtypes) of lung cancer, and each one works in a different way.
Oncologists use detailed tumor analysis to determine the specific category or subtype of lung cancer in a patient, which helps them make the best treatment decisions.
Based on the size, shape, and microscopic appearance of cancer cells, there are 2 main types of lung cancer: (1) non-small cell lung cancer and (2) non-small cell lung cancer (NSCLC). About 85% of people with lung cancer have NSCLC.
NSCLC has several subtypes. To find out which subtype of NSCLC a patient has, doctors perform 2 types of tests: pathology (or tissue structure) and biomarker tests.
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Pathology tests are performed by doctors who look at the histology (appearance) of NSCLC cells under a microscope. These doctors (pathologists) are experts in cancer diagnosis. They will pay attention to the size and shape of the cells and find out whether the patient has squamous cells (about 30%) or non-squamous cells (70%).
It is usually associated with a history of smoking and occurs in the central part of the lung, near the main airways or bronchi.
Adenocarcinoma, the most common subtype of NSCLC, begins in the cells that make up the lining of the lungs.
Advances in science over the past few years have allowed cancer specialists to obtain more detailed and accurate information to help tailor treatment for each patient. In addition to examining the histology of NSCLC, oncologists examine NSCLC biomarkers, as do squamous and non-squamous cancer specialists.
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Biomarkers are biological molecules found in blood, other body fluids, and tissues that are indicative of normal or abnormal processes, conditions, or diseases.
Biomarkers are used to see how well the body is responding to treatment for a disease or disorder. For lung cancer patients, biomarker testing can look for specific characteristics. After the pathologist shares the biomarker results with the oncologist, the team can consider using targeted therapies that may be more likely to be successful.
It is important to understand that the language used by cancer professionals regarding biomarker testing may differ from one specialist to another. “Biomarker testing,” “molecular testing,” and “genetic testing” are essentially the same thing. Oncologists and other medical professionals often use these terms interchangeably.
Gene mutation is a type of biomarker. These are changes that occur in the genetic “blueprint” of the cell, or DNA (Table 2).
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For example, people with prostate cancer have high levels of lactate dehydrogenase (LDH) in their blood. Blood tests show whether these LDH levels decrease during cancer treatment, which helps doctors and patients know if cancer treatment is working.
Patients with NSCLC may also be screened for the PD-L1 protein, which can help determine whether a patient’s tumor will respond well to certain immunotherapy drugs.
Today, more than 75% of patients with NSCLC, particularly adenocarcinoma, have genetic mutations, and oncologists can target one or more drug therapies that can reverse specific mutations.
For other NSCLC patients whose genetic mutations have not yet been approved, scientific research is devoted to finding effective treatment options.
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A common mutation in NSCLC can occur in the gene that controls the epidermal growth factor receptor (EGFR).
EGFR is a protein found on the body’s cells, including cancer cells. If
The mutated gene causes the EGFR protein on the surface of the cell to become overactive, causing cancer cells to grow rapidly.
Positive” NSCLC. Drugs called EGFR inhibitors (or blockers) have been approved by the US Food and Drug Administration, the European Medicines Agency and other regulatory agencies around the world and can be offered to patients with this condition.
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In other types of NSCLC, cancer growth is partially driven by structural changes in anaplastic lymphoma kinase.
Genetic modification means that one gene combines with another gene to create a new gene. In some lung cancers
The gene fusion, seen in about 8% of patients with NSCLC, produces an overactive ALK protein that can stimulate the growth of cancer cells.
Less known mutations are recommended for all patients with NSCLC that has spread to other parts of the body, including adenocarcinoma, large cell lung cancer, and unknown subtypes.
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Drugs called ALK inhibitors are available in the United States and Europe, as well as in other parts of the world, and are an option for patients with the disease.
For these patients, different factors such as genetic vulnerability and exposure to carcinogenic chemicals (secondhand smoke, air pollution, radon, asbestos, etc.) are factors in the development of the disease (Figure 4).
Nonsmokers diagnosed with NSCLC are often diagnosed at a younger age and may have some genetic changes.
Doctors treat lung cancer patients with a variety of treatments, including radiation, surgery, and chemotherapy. Although effective in many patients, these treatments are difficult to tolerate, in part because they kill normal healthy cells while killing cancer cells. Today, with a more complete understanding of how cancer cells work, researchers have developed drugs that target specific genetic changes, such as NSCLC-specific mutations and abnormal proteins.
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The medical community now understands that blocking certain internal communication and signaling pathways in cancer cells can slow or stop the growth of these cells. Using this knowledge, unique drugs have been developed that can block and “inhibit” specific signaling pathways in cancer cells. As a group, these drugs are called “targeted” therapies.
This means that some patients with NSCLC (and some patients with other types of cancer) can be treated more precisely. This idea
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